- 期刊
Rhinocerebral Mucormycosis Manifesting as Intractable Headache and Accompanied By Acute Cerebral Infarction: Case Report
鼻腦白黴病以難以治療的頭痛表現並伴隨急性缺血腦中風：個案報告
摘要
一位70歲男性，持續10天劇烈頭痛，至多家醫院急診室求診仍未改善。因症狀持續被送至本院急診，理學檢查發現左顳部刺痛、鼻塞、流鼻水併臉部疼痛，臆斷為鼻竇炎住院治療；住院後發現左上硬腭有黑色焦痂，之後發展為左側眼盲、意識改變，會診耳鼻喉科切片檢查為鼻腦白黴病並給予抗黴菌藥物治療。病人過去一向身體狀況良好，住院期間檢查有高血糖。因病人狀況危急且家屬拒絕開刀治療，病患於住院後數日死亡。本病人接受一系列電腦斷層及核磁共振檢查伴隨發現左側額葉急性缺血性中風。結論是對於無法解釋的頭痛併臉部疼痛，尤其是有發燒和鼻竇症狀的免疫缺陷病人，應考慮鼻腦白黴病的可能性。
並列摘要
Mucormycosis is a rare opportunistic fungus infection and cerebral invasion is a very rare complication of this condition. A 70-year-old man suffered from a severe left temporal pricking headache, nasal obstruction, rhinorrhea and facial pain, and was admitted under the impression of intractable headache and acute sinusitis. Blindness in the left eye, and mucosal eschar over the left side of the hard palate were found. Then the patient developed a consciousness change. Human immunodeficiency virus (HIV) was not detected, but hyperglycemia was noted. Nasal biopsy revealed mucormycosis and inflammation. Systemic antifungal therapy with Amphotericin B administration was immediately begun but his family refused extensive surgical debridement due to his critical condition and the treatment was unsuccessful. Although relatively rare, a diagnosis of a rhino-orbital-cerebral mucormycosis should be taken into consideration in the evaluation of unexplained temporal headache with mucosal eschar or ulcer over the palate, especially in an immunocompromised host with fever and symptoms of sinusitis.
延伸閱讀
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